Studies have indicated that relapse is noted as a major problem facing mental health services both nationally and internationally whereby family members caring for mental health care users experience a serious burden. Factors commonly associated with relapse include poor adherence to treatment, substance abuse, co-morbid psychiatric illness, a co-morbid medical and or surgical condition, stressful life events and the treatment setting. Relapse prevention strategies have been identified and they include, empowering people with mental illness to recognize early warning signs of relapse in order to develop appropriate response plans as well as communication and understanding between the mentally ill person, their family, and specialist mental health system and community support services. The researcher was prompted by the problem of relapse faced by mental health services to explore and describe the strengths of families in assisting mental health care users to limit relapse and to formulate guidelines for psychiatric nurses to empower family members caring for mental health care users to limit relapse. A phenomenological design was used in this study and a purposive sampling technique was used to select participants who met the selection criteria. In-depth individual interviews were conducted with 15 family members. All interviews were recorded with an audio recorder after participants gave consent. Data saturation was achieved after 13 participants were interviewed and further two interviews confirmed data saturation. Field notes were written immediately after each interview. Data analysis was done according to Tesch as quoted by Creswell (2007:187) and the researcher and co-analyzer reached consensus on the themes in a meeting. The findings of research resulted in four main categories namely, accepting the condition of a mentally ill family member, having faith in God, involving a mentally ill family member in daily activities and being aware of what aggravates the mentally ill family member. The conclusion that can be made is that “acceptance through education” assisted family members in developing a positive attitude and acceptance of their feelings as well as the condition of their mentally ill family members. A strong spiritual base provides family members with strength and hope in times of adversity and teaches them how to have healthy relationships within the family unit and with others. It is also evident that sharing activities, as the things that all members of the family do together, reinforce and strengthen their togetherness and that if family members can be aware of what aggravates mentally ill family members by communicating well with them, that can bring harmony in families and ultimately limit relapse. Recommendations in this research are made for nursing education, nursing research and psychiatric nursing practice with guidelines for psychiatric nurses to empower families caring for mentally ill family members to use their strengths and contribute to limiting relapse. / MCur, North-West University, Potchefstroom Campus, 2014

Magister Public Health - MPH / The Zambia Demographic Health Survey reports that 81% of the population of Mansa District, Zambia lives in extreme poverty. Eleven percent (11%) of this population is estimated to be HIV positive. Many of this HIV positive population were the primary breadwinners in their households prior to the onset of AIDS. The majority of them are cared for by family members (PCGs) with limited training. Home Based Care programmes provide care and support to patients at their homes. However, this support does not extend to the caregivers. This explorative study investigated the psychological, social and informational needs of primary caregivers of AIDS patients in Mansa District, Zambia. It was envisaged that the findings of the study would assist home-based care organizations to provide comprehensive support and care to the primary caregivers, in addition to patients. Methods A qualitative research approach was chosen to gain an in-depth understanding of healthrelated experiences of caregivers while taking into consideration the context within which this phenomenon takes place. Twenty-six caregivers who provide basic care and support to family members who had advanced HIV-disease were recruited into the study. All AIDS patients in the study were former breadwinners of their households. Purposive, maximum variation sampling was used to select non-homogeneous cases of family caregivers, who provided services to AIDS patients within their homes. It was envisaged that such a heterogeneous sample would provide wide variations in experiences, and this would contribute to the range of issues pertaining to caregiver needs being covered. Three Focus group discussions were conducted, audio-tape recorded and transcribed. Findings The findings of the study highlight that caregivers have the following psychological needs: reciprocated sympathy and appreciation from society and their patients, stress coping mechanisms, and the capacity to display patience despite unreasonable demands made by the patients for whom they are caring. The study highlights that caregivers face numerous challenges in dealing with conflicting relationships and in handling stigma and discrimination, and that they are in need of a strong social support network. It also emphasizes that many of the primary caregivers lack adequate information about social services organizations that can assist them with training. The training will enable those (PCGs) to provide care in a manner that does not compromise the safety of the patients or themselves, as well as give them opportunities for education and skills development for income generation that will make it possible for them to provide for the upkeep of the family. Conclusions Home-based care workers are best placed to support PCGs at home. The training of such home-based workers should be extended to take in consideration the specific needs of these caregivers. In addition, the role of primary caregivers should be acknowledged in national HIV/AIDS strategies.

Bakgrund När en närstående insjuknar i svår sjukdom och står inför palliativ vård i livets slutskede drabbas såväl patienten som dess närstående. Tidigare roller kastas om och känslor likt hjälplöshet och otillräcklighet blir ett faktum, inte minst hos de närstående vilka snart kommer att mista en nära vän eller familjemedlem. Närståendes närvaro vid den sista tiden i livet är betydelsefull för båda parter, men innebär även sorg både under sjukdomstiden och efter dödsfallet. Syfte Syftet är att belysa närståendes behov och upplevelser när en familjemedlem vårdas med palliativ vård i livets slut. Metod Strukturerad litteraturstudie med inslag av systematisk översikt vilket beskriver aktuell forskning och kunskap inom det valda området. Sökning har utförts i databaserna PubMed och CINAHL. Resultat Närstående har ett stort behov av vårdpersonalens fysiska och emotionella närvaro. De upplever svårigheter att ta initiativ till samtal gällande döden och vad som väntar i samband med en närståendes bortgång. Genom god kommunikation kan närståendes behov av att känna sig delaktiga tillgodoses. Slutsats Närstående behöver inkluderas i den palliativa vården av patienten för att delaktighet ska främjas. Det finns även ett stort behov av att vårdpersonalen är påläst och vågar ta initiativ till förberedande samtal om döden. Egen tid för reflektion och samtal ansågs viktigt närstående och patienter emellan, men det är även viktigt för de närstående enskilt. / Background When a relative falls ill with a serious illness, and faces end-of-life care, both the patient and their relatives are affected. Previous roles are being changed, and feelings like helplessness and inadequacy become a fact, not least among those close to them who will soon lose a close friend or family member. The presence of close relatives at the last time in life is important for both parties, but also means grief both during the illness and after the death. Aim The aim of this study is to illustrate relatives’ needs and experiences in palliative care at the end of life. Method This is a structured literature study with elements from a systematic review which describes current research and knowledge within the chosen area. PubMed and CINAHL have been used to search for scientific articles. Results There is a huge need of physical and emotional presences from the nursing staff. Family members experience difficulties to initiate conversations about death and what to expect when a family member passes away. By communicating with family members, the nursing staff can please the family members’ need of being involved. Conclusions Family members need to be included in decision making about the patient's end of life care. By being included in decision making, the nursing staff can please the family members’ need of being involved. There is a huge need to feel that the nursing staff is well informed about the patient's status, and that they dare to take the initiative to talk about death. Time for reflection and conversations between family members and the patient, but also family members in private is important.

Introduction : Les personnes ayant eu un accident vasculaire cérébral léger (AVCL) sont autonomes pour l’accomplissement des activités de la vie quotidienne de base, mais peuvent présenter des déficits subtils pour l’accomplissement d’activités complexes qui ne sont pas dépistés durant l’hospitalisation. Le retour à domicile parmi les proches est souvent le moment où certaines difficultés apparaissent. L’objectif de cette étude est d’explorer la perception des proches de leur qualité de vie, trois mois après le retour à domicile de la personne ayant eu l’AVCL. Méthodologie : Cette étude qualitative repose sur un paradigme constructiviste. Des entrevues individuelles semi-dirigées ont été menées à l’aide d’un guide d’entrevue, auprès de proches de personnes ayant eu un premier AVCL trois mois auparavant. Une transcription du contenu des entrevues a été faite sous forme de verbatim, suivie d’une analyse de contenu. Résultats : Huit entrevues ont été complétées (âge moyen 56,9 ans – ratio hommes/femmes de 2/6). Six thèmes ont été identifiés : personne ayant eu l’AVCL, vie quotidienne, relation conjugale, récidive, santé et services. L’AVCL engendre plusieurs incapacités (personne ayant eu l’AVCL) et les proches interrogés rapportent une augmentation de leurs tâches quotidiennes ce qui limite leurs activités personnelles (vie quotidienne). Ils mentionnent également devoir passer du rôle de conjoint à celui de parent, ce qui modifie la dynamique de couple (relation conjugale). Les proches se disent anxieux face au risque de récidive (récidive) et certains présentent des malaises physiques comme des maux de tête et un manque d’énergie (santé). Les proches affirment n’avoir accès à aucun service et que le seul soutien dont ils bénéficie est celui de leur entourage (services). Conclusion : Le retour à domicile de la personne AVCL engendre diverses conséquences sur le quotidien des proches, ce qui affecte leur qualité de vie. / Introduction: Mild stroke clients are often independent in basic activities of daily living but may present subtle deficits that impact on complex activities and roles. The purpose of this study was to explore the perceived quality of life of close family members three months after the stroke client was discharged home. Method: Qualitative design based on a constructivist paradigm. Interviews were conducted with family members of mild stroke clients three months after discharge. An interview guide was used and the audio content was transcribed, followed by a content analysis. Results: Eight interviews were conducted (mean age 56.9 ± 9.2 years; men=2/8). Six essential themes emerged from the data. According to participants, mild stroke clients present sequelae that interfere with complex tasks (patient), increasing the burden on other family members who have to limit their personal activities (daily living). Spouses reported sometimes acting like a parent, which caused tensions in the relationship (conjugal relationship). Anxiety is related to the risk of stroke recurrence (relapse) and some family members present physical symptoms and a lack of energy (health). However, family members do not have access to services despite support from their relatives (services). Conclusion: The results of this exploratory study strongly suggest that even a ‘mild’ stroke has an impact on the daily lives of close family members and affects their quality of life.

This thesis deals with analysis of EU rules on entry and residence on the territory of Member States. These rules are described from the perspective of different groups of people, EU citizens, citizens of EFTA Member States, family members or citizens of Turkey, and also from the perspective of Member States participating in the Schengen Border Area and Member States outside this Area. The core of this thesis consist is the analysis of four key EU rules in this field, namely the Border Code (Regulation 562/2002), the Visa Code (Regulation 810/2009), the 539/2001 Regulation and the 2004/38 Directive, as well as relevant case law of the Court of Justice, that influences the interpretation of the rules in hand significantly. The rules are also assessed from the point of view of principles of legal certainty and legitimacy.

Introduction : Les personnes ayant eu un accident vasculaire cérébral léger (AVCL) sont autonomes pour l’accomplissement des activités de la vie quotidienne de base, mais peuvent présenter des déficits subtils pour l’accomplissement d’activités complexes qui ne sont pas dépistés durant l’hospitalisation. Le retour à domicile parmi les proches est souvent le moment où certaines difficultés apparaissent. L’objectif de cette étude est d’explorer la perception des proches de leur qualité de vie, trois mois après le retour à domicile de la personne ayant eu l’AVCL. Méthodologie : Cette étude qualitative repose sur un paradigme constructiviste. Des entrevues individuelles semi-dirigées ont été menées à l’aide d’un guide d’entrevue, auprès de proches de personnes ayant eu un premier AVCL trois mois auparavant. Une transcription du contenu des entrevues a été faite sous forme de verbatim, suivie d’une analyse de contenu. Résultats : Huit entrevues ont été complétées (âge moyen 56,9 ans – ratio hommes/femmes de 2/6). Six thèmes ont été identifiés : personne ayant eu l’AVCL, vie quotidienne, relation conjugale, récidive, santé et services. L’AVCL engendre plusieurs incapacités (personne ayant eu l’AVCL) et les proches interrogés rapportent une augmentation de leurs tâches quotidiennes ce qui limite leurs activités personnelles (vie quotidienne). Ils mentionnent également devoir passer du rôle de conjoint à celui de parent, ce qui modifie la dynamique de couple (relation conjugale). Les proches se disent anxieux face au risque de récidive (récidive) et certains présentent des malaises physiques comme des maux de tête et un manque d’énergie (santé). Les proches affirment n’avoir accès à aucun service et que le seul soutien dont ils bénéficie est celui de leur entourage (services). Conclusion : Le retour à domicile de la personne AVCL engendre diverses conséquences sur le quotidien des proches, ce qui affecte leur qualité de vie. / Introduction: Mild stroke clients are often independent in basic activities of daily living but may present subtle deficits that impact on complex activities and roles. The purpose of this study was to explore the perceived quality of life of close family members three months after the stroke client was discharged home. Method: Qualitative design based on a constructivist paradigm. Interviews were conducted with family members of mild stroke clients three months after discharge. An interview guide was used and the audio content was transcribed, followed by a content analysis. Results: Eight interviews were conducted (mean age 56.9 ± 9.2 years; men=2/8). Six essential themes emerged from the data. According to participants, mild stroke clients present sequelae that interfere with complex tasks (patient), increasing the burden on other family members who have to limit their personal activities (daily living). Spouses reported sometimes acting like a parent, which caused tensions in the relationship (conjugal relationship). Anxiety is related to the risk of stroke recurrence (relapse) and some family members present physical symptoms and a lack of energy (health). However, family members do not have access to services despite support from their relatives (services). Conclusion: The results of this exploratory study strongly suggest that even a ‘mild’ stroke has an impact on the daily lives of close family members and affects their quality of life.

Experiencing the death of a family member at a young age is a confusing time for many children. Some clinicians have reported that parental death is the most stressful life event for children, and some studies have traced adults' mental health difficulties to unresolved childhood grief (Balk, 1983; Krahnstoever, 2006). Despite the hardships endured after a family member's death, some children manage to endure the pain of loss better than others because they are resilient due to a variety of protective factors (Masten, 2003; Bonanno, 2004). The present study examined the relationships between childhood grief, potential protective factors (social support, physical and academic self-concept, parent-child relationship quality) and adolescent outcomes (depression, social satisfaction, and academic achievement). Longitudinal data from the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care (SECC) was utilized in the present study. The sample consisted of 1,364 children, including 261 children who experienced the death of at least one family member in third or fifth grade. There were twelve moderation analyses that were used to examine buffering effects in the present study. Findings in the present study did not support the hypotheses that the psychosocial factors examined could be protective factors between experiencing the death of a family member and the adolescent outcomes examined. Results also revealed a significant main effect of social support, parent-child relationship quality, and physical and academic self-concept whereby those with higher levels of these psychosocial factors tend to have lower levels of depression. Having higher physical and academic self-concept was found to be positively associated with academic achievement. Contrary to what might be expected, a main effect of having higher levels of social support, parent-child relationship quality, physical self-concept, and academic self-concept were associated with lower levels of social satisfaction. Although the hypotheses were not supported in the present study, it is still important that the topic was examined and findings from the present study can guide future research in further exploring possible protective factors for children who experienced the death of a family member.

This diploma thesis deals with the theme of changing the life values in the context of the death and dying. The theoretical part is divided into two sections. First of them is focused on the attitudes to the death by the various disciplines, the second one is focused on the life values, specifics and experience with the process of dying. The practical part maps the attitudes to the death by the three groups of respondents ? the group of dying clients of hospices, the group of their family members and the last is the group of the staff (of residence and home hospice care). There are compared their responses with the results of another researches and thesis dealing with analogous topic in the Discussion. The main result of this thesis is that the most important values accented by the contact of the coming death are not the material values (like money, possesion), but the values connected with the quality interpersonal relations and family background like esteem, love, loyalty, devotion and gratitude is.

Il presente lavoro, riconoscendo la rilevanza che le aziende familiari detengono all’interno del contesto internazionale, con particolare riferimento a quello italiano, si propone di analizzare la loro propensione verso l’implementazione della strategia di acquisizione. In particolare lo studio, composto da tre paper tra loro connessi, è volto a delineare una “fotografia” del tessuto imprenditoriale italiano rilevando le caratteristiche delle aziende familiari e della tipologia delle operazioni di crescita per via esterna da queste conseguite. Inoltre, la ricerca fornisce delle comparazioni con le operazioni svolte dalle imprese non familiari così da comprenderne similitudini e differenze evidenziando come la partecipazione della famiglia proprietaria, sia in termini di proprietà che di gestione, incida sulla predisposizione ad acquisire. Il primo paper indaga l’attitudine delle imprese familiari e non familiari ad acquisire, mostrando tipologie e caratteristiche delle operazioni di crescita per via esterna da queste conseguite nel periodo 2000 – 2014. Il secondo lavoro, approfondito il ruolo della distanza culturale ed economica tra acquirente ed acquisita, verifica se le aziende familiari hanno economicamente beneficiato dell’implementazione della strategia di crescita per via esterna. Il terzo contributo analizza come le differenti modalità e livelli di coinvolgimento diretto della famiglia alla vita d’impresa incida sulla predisposizione ad acquisire. / The aim of this work, which recognizes the importance of family-owned firms in the international environment – focusing in particular on the Italian context – is to analyze their propensity to implement the acquisition strategy. The study, composed of three interrelated papers, is intended to “take a picture” of the Italian entrepreneurial fabric, by detecting the features of family firms and the type of growth operations through acquisitions. Furthermore, this research outlines comparisons with the operations led by non family firms, in order to understand similarities and differences by highlighting how the role of family owner, both in terms of property and management, influences the propensity to acquire.  The first paper examines the propensity of family and non family firms to acquire, showing the types and features of the growth operations through acquisitions in the timeframe 2000 - 2014. The second paper, after studying in depth the role of the cultural and economic distance between the acquirer and target, checks whether family firms benefitted from the implementation of acquisition. The third paper analyses the influence of the several implementation procedures and the level of direct involvement of the family in the life of the firms on the propensity to acquire.

MCur / Department of Advanced Nursing Science / Background: In South Africa the Mental Health Care Act No. 17 of 2002 direct district hospitals to render 72-hour assessment of the MHCU’s. In Vhembe district 72- hour assessment is implemented in public general hospital. Purpose: The study determined the experiences of family members regarding 72-hour assessment admission of MHCU’s at selected hospital in Vhembe District. Methodology: The research design was qualitative, exploratory, descriptive and contextual in nature. The study population consisted of the family members of the MHCU’s admitted for 72-hour assessment. Purposive sampling was used to select 10 family members. This study used in-depth individual interviews to collect data until data saturation was reached and analysed using Tesch’s steps. Ethical consideration and measures to ensure trustworthiness were given attention to throughout the study. Results: Three themes emerged from analysed data which is negative experiences of family’s members, family member’s experience on coping mechanism and structural constraints. Recommendations: This study recommends further research study on the development of a model to support the family members in their caregiving role The study recommends further research study on the experiences of the health care professional regarding 72-hour assessment of a MHCU’s / NRF